My name is Steve, and I am a recovering defendant.
It has been a little over 15 years since I was last sued in a medical liability case, but the experience is still with me today.
Attorneys seem to be able to take these things fairly lightly. Sure, they work hard, and argue their clients' cases passionately. But at the end of the day, win or lose, they go home and start working on the next case. Maybe it is different when they are the ones being sued. Where you stand on an issue often depends on where you sit.
Physicians I have met who have been sued, though, have trouble not taking these things personally. They put a great deal of themselves into their patient care, and a lawsuit alleging that they have been negligent in that care or that they have not met the "standard of care" for their patients is often felt as a personal, as well as a professional, failure, even if they feel the care they rendered was appropriate at the time. And even if there was no wrongdoing, there is still a prolonged period of self doubt and agony leading up to the trial. Then there are the depositions and the trial itself, when the physician's life is examined under a microscope looking for flaws.
An "expert" witness for the plaintiffs at my trial testified that the standard of care required that any patient with chest pain unexplained by an abnormal EKG must have a CT of their chest. My malpractice provider even informed its other insured clients that this would now have to be considered the standard of care in our area. Although I was found not guilty by unanimous verdict in my trial, I would estimate I have ordered 4 or 5 chest CT's a month ever since then to avoid ever being put in such a situation again.
The costs in money and radiation exposure of this one change in practice is large. When multiplied by many other physicians who do not wish to undergo the personal agony and humiliation of leaving themselves and their families open to the possibility of a lawsuit, the cost is enormous. Estimates of the annual costs of "defensive medicine" are in the $100 to $200 billion range. These are likely underestimates of the costs, since the documented "indication" for a procedure is never stated as such. 83% of physicians reported they practice "defensive medicine" in a survey by the Massachusetts Medical Society last year (http://www.massmed.org/AM/Template.cfm?Section=Advocacy_and_Policy&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=23559). They reported that 18 to 28 percent of tests, procedures, referrals and consultations, and 13 percent of hospitalizations were ordered for defensive reasons.
I have survived the death of two parents and a spouse. When these deaths occurred, I never had the inclination to find someone to blame...someone to sue. In our grief and pain the death of a loved one seems "wrong," but every death is not "wrongful." We are mortals, and none of us will get out of this alive. Ultimately, our expected mortality rate is 100%, even with appropriate medical care.
Our current medical tort system does more than damage our budgets. It damages the trust our patients have for their doctors, and the trust our doctors have for their patients.
Until we are ready to recognize these economic and personal costs, and enact meaningful tort reform, we will not be able to enact meaningful healthcare reform.
Sunday, August 30, 2009
Saturday, August 15, 2009
These Pills Work Best When Taken Internally
A patient was referred to me for treatment of refractory hypertension. Her medication list was quite long, and I reviewed the medications with her, I asked "How many times a day do you take this one?" She took the bottle, and looked at it for a moment, and replied "I don't take this one at all. I just keep it on the nightstand." When I asked her why she wasn't taking it, she told me "Doctor, I just don't like to take medicine." I spent some time explaining to her the need to control her blood pressure to prevent a heart attack or stroke or kidney disease down the road, and that the pills were not likely to work by sitting on the nightstand. They needed to be taken internally.
The benefits of treating high blood pressure, high cholesterol, and diabetes are well documented. These treatments are cost effective, because of the reductions in cardiovascular disease they yield over time. The problem, though, is that patient acceptance and compliance are variable.
A new study released by the New England Healthcare Institute last week estimates that one-third to one-half of patients in the US do not take their medications, as prescribed. It estimates the increased cost of healthcare for these patients, based on increased needs for hospitalization, treatment of uncontrolled conditions, and early deaths at $290 billion annually. It also shows that patients with chronic diseases are less likely to take their medication correctly than are patients with an acute problem.
After all, a pain medicine can make you feel better quickly. An antibiotic can clear up an infection in a few days. While there may be some early reduction in blood pressure or cholesterol when treatment is started, blood pressore and cholesterol medications do not make you feel better on a daily basis.
It takes education and a receptive patient who is willing to endure the cost and inconvenience of taking medication daily to achieve the future benefit of preventing health problems later in life.
Prescribing medication is easy. Assuring that the patient will be a compliant partner in the treatment plan is not. Clearly, though, the medications work better when taken internally.
The benefits of treating high blood pressure, high cholesterol, and diabetes are well documented. These treatments are cost effective, because of the reductions in cardiovascular disease they yield over time. The problem, though, is that patient acceptance and compliance are variable.
A new study released by the New England Healthcare Institute last week estimates that one-third to one-half of patients in the US do not take their medications, as prescribed. It estimates the increased cost of healthcare for these patients, based on increased needs for hospitalization, treatment of uncontrolled conditions, and early deaths at $290 billion annually. It also shows that patients with chronic diseases are less likely to take their medication correctly than are patients with an acute problem.
After all, a pain medicine can make you feel better quickly. An antibiotic can clear up an infection in a few days. While there may be some early reduction in blood pressure or cholesterol when treatment is started, blood pressore and cholesterol medications do not make you feel better on a daily basis.
It takes education and a receptive patient who is willing to endure the cost and inconvenience of taking medication daily to achieve the future benefit of preventing health problems later in life.
Prescribing medication is easy. Assuring that the patient will be a compliant partner in the treatment plan is not. Clearly, though, the medications work better when taken internally.
Thursday, August 13, 2009
Thursday, August 6, 2009
The Lowest Bidder
Our pilots take comfort in knowing that they go to battle in fighters manufactured by the lowest bidder. Why shouldn't we all feel better knowing that our healthcare will be provided by the lowest bidder?
Subscribe to:
Posts (Atom)
